NEW LOW PRICING!Video Memberships for personal viewing.
Access to over 300 of the best psychotherapy
training videos starting at $29/month.

What is Object Relations Therapy?

Rafal Mietkiewicz: Jill, you are a renowned psychiatrist, psychoanalyst and object relations therapy expert. You’ve written and edited many books on object relations therapy so I’m wondering if we can start with just a basic overview of what object relations therapy actually is. It can seem like rocket science to beginning therapists.

Jill Savege Scharff: It’s an unfortunate term, “object relations,” but it was chosen in deference to Freud’s use of the term “object,” which refers to the object that the drive to be in relationship attaches to. Freud talked about the sexual and aggressive drives later in his life, the life and death drives. Fairbairn, who introduced the term “object relations theory,” talked about people’s main motivation being to be in relationship, not only for love an security, but also for a sense of meaning. Giving meaning to existence.

It’s not just the mother who gives meaning to the baby, but the baby who gives meaning to the mother, who becomes a mother because she has the baby to relate to and care for. Object relations refers to the internal psychic structure that develops from these early experiences.

RM: And as therapists our job is to search for these internal structures in our clients?

JS:

Intimate relationships provide an opportunity to rediscover the internal object relations in a new dimension—one that may help it grow and change.

You don’t have to search very far because that internal structure is written large in external, current relationships. The internal relations operate as a kind of design that leads people to repeat it in their current relationships—partly because it’s familiar, and they want to recreate what they know, and partly to have new experiences that, if they’re healthy and interesting and challenging may encourage new learning so that modifications in the original object relations can be made. Intimate relationships provide an opportunity to rediscover the internal object relations in a new dimension—one that may help it grow and change. Same is true in therapy. Does it still sound like rocket science, Rafal?

RM: Yes, a little bit. It seems like it would take a long time to unwind these long-term patterns, and that the therapy would go quite deep.

JS: It does take time to create deep character change. It can take a couple of years with couples.

RM: I am a working therapist, and I have my own experiences in both individual and marital therapy, but the idea of working with a couple for a couple of years sounds challenging, to be honest.

JS: Well, that’s more for couples who are looking for radical change. Some couples come in and just want a little adjustment. They want to settle a fight, or they want to decide whether or not to have a child, and it’s just a developmental intervention. A developmental challenge has got them stuck, and after few sessions they’re on their way. But others who have tremendous difficulties relating, communicating, establishing an intimate sexual relationship—these therapies take longer.

RM: So you distinguish between a developmental intervention and deep therapy.

JS: Well, you never want to do too much. You just want to do what people are looking for and what they need. With an object relations approach, which does operate in depth, even in a few sessions you can show a couple what that approach could offer them if they chose it, if they chose to invest in something more substantial.

RM: When you see a couple, what are the initial stages?

JS: First we do a consultation—not therapy—because I want to give the couple a chance to decide if they think we’re a good match, and I want to show them my style of working. Not every couple chooses to work in an object relations framework, which is basically psychoanalytic framework. Some are looking for a shorter-term approach, or a more structured approach, or a more direct of approach, in which case I’ll refer them.

RM: So the first stage is consultation.

JS: Yes, I’ll meet for maybe two or three sessions. Some people will meet with one partner once, the other partner once, and the couple once. But unless there’s a specific indication to do that, I usually prefer to just work with the couple.

RM: What would be the special indication?

JS: If there is an autonomous individual psychiatric problem, such as a deeply established substance abuse problem, I might want to meet with that individual to assess the extent of it and decide if individual treatment is a better option, maybe even a rehab program. Another indication is the wife or husband of a therapist. Sometimes, you’ll find that non-therapist is so far behind the one who is trained as a therapist, in terms of communicating emotional experience, that they sometimes need an individual session away from the therapist-partner in order to find the words to speak to the therapist partner.

RM: Can a couple’s therapist join these two functions, and do individual therapy with one person from a couple, while also doing therapy for the couple?

JS: That can happen as long as you’re very aware that your commitment is to the couple and that anything you do with the individual comes back into the couple meeting. That the confidentiality, for instance, pertains to the couple, not to the individual member of the couple. So let’s say the individual tells you about an affair that they haven’t told their partner, you would not reveal that personally, but you would suggest they bring it up in couples therapy. If they can’t do it, you probably find yourself unable to work with the couple because if you have a piece of information that you can’t use, it blocks you from being able to respond to all the clues that lead to that conclusion, which you can’t then make.

RM: You also can’t free associate, because you’re blocked from going in certain directions.

JS: You’re absolutely right. I was in Poland last week, and I heard that the Family Therapy Association is working on a statement about confidentiality and how it pertains to couple and family therapy.

The Couple’s Unconscious Life

RM: How do you assess whether a couple is suitable for object relations therapy.

JS: I’m looking for how they respond to any interpretations I make, to my overall presentation, to any links I make between the current struggles and the past. If I get someone who doesn’t want to deal with the past, who says “The past is the past and I don’t want to think about it,” they aren’t likely a good candidate for therapy with me.

If I get someone who doesn’t want to deal with the past…they aren’t likely a good candidate for therapy with me.

So I might say, “Well, okay, I can try to work with you just on the present, but I know that everything that happens now is informed by what happened before, so I don’t think that this kind of therapy will suit you. Do you want to try it and see it what it can do for you, or would you prefer something else?”

I always like to work with couples who can work with their dreams, but not all couples are willing to do that. Some think their dreams are very private to the individual. To me, once an individual tells a dream in couples therapy, it becomes a dream of the couple that the couple has shared with me and that helps me have access to the couple’s unconscious life. The whole of object relations therapy is geared to getting access to the impact of the unconscious on the relationship.

RM: What’s your technique for working with a couple’s dream?

JS: Well, first of all, I listen to the dream from the individual. Then I ask the individual what has occurred to them about the dream. Then, I ask the partner what comes up for them in relation to the dream. Then, as a couple, they’re now talking about this dream, and I look for their associations, my own associations, the feelings it elicits in them and myself, and I construct an interpretation of the dream and what it conveys about the current of their relationship and what they hope for, what they wish for, for themselves in the relationship.

RM: I have always found that working with dreams is great in individual therapy, but this opens a new ocean of possibilities working with couples. Once you’ve done the consultation sessions, and you’ve got the couple on board for treatment, what next?

JS: We agree on the frequency of therapy, which will be once or twice a week. I like my sessions to be 45 minutes, but for couples who come a long distance, we might work for an hour or an hour and a half, whatever suits them. But by arrangement, not just running over time; we agree ahead of time what will be the best format. I don’t do questionnaires. I just ask them to come into the room. They sit.

Can you see my room? [Interview is being done via Skype]

RM: Of course, I see two armchairs.

JS: There are two red chairs over there. They sit in those chairs. I sit back here near the desk. There is a couch down that wall, past the printer. Some couples will sit together on the couch. Sometimes one will sit on the couch in a rather narcissistic way while the other will perch on the chair. However they sit, it’s of interest how they relate themselves to me, how they relate to each other, in spatial terms.

And then I just ask them to say whatever they want to say. Just come in and start. I don’t ask questions. I just listen, and I respond. I think my manner is sort of socially appropriate, unobtrusive, nondirective. It’s not remotely analytic as we’ll sometimes imagine analysts to be. And I’m not saying all the time, “And what do you think about that?”

A Couple's State of Mind

RM: You’re not?

JS: “And how does that make you feel?” No, it’s more that we’re just having an open space conversation, really. And then, every so often, I’ll arrive at a construction of what I think has been happening and show them their repeating patterns of interaction and how they connect to their early experiences. How they treat each other as people from the past were treated or treated them. I’m very interested in helping them as a couple to develop what Mary Morgan calls “a couple’s state of mind.”

You get some couples who used to think as a couple, plan as a couple, and who, because of the strains and stresses of their life and the emergence of negative aspects of their characters, have lost that ability. And then other couples come in who have never actually had it.

You get some couples who used to think as a couple, plan as a couple, and who, because of the strains and stresses of their life and the emergence of negative aspects of their characters, have lost that ability. And then other couples come in who have never actually had it. They come as two individuals. Each one thinking what he or she is doing and not understanding that the marriage is a thing in and of itself that they each contribute to the shaping of, the nurturing of, the maintenance of. If they can learn to do that, then the marriage offers them a great deal.

It’s not just that the partners take care of and love each other, but also the partnership or marriage that they construct. I’m not saying they have to be married in a church or anything, but if they made a commitment to be together, and they nurture that relationship, it will then nourish them and support them through the life cycle and through the various challenges of having the first child, the first child leaving home, retirement—whatever comes through life.

RM: Is one course of therapy enough for a couple or do they tend to come in and out over time?

JS: I think most couples, if they work for a couple years and get to the appropriate developmental level, then they have the tools they need when challenges come up. But you can never predict what life will throw in the way of a couple, and some things might overwhelm their capacity to adapt. If that’s the case they may come back for another session or series of sessions.

The Death of the Couple

RM: What techniques do you use? Do you give interpretations?

JS: I’m a little bit allergic to the term “techniques.” It sounds like they’re little things you apply in various circumstances.

I tend to think of technique more generally as a way of listening, observing, waiting, holding anxiety, not jumping to action, not becoming directive, of always following the affect.

I tend to think of technique more generally as a way of listening, observing, waiting, holding anxiety, not jumping to action, not becoming directive, of always following the affect. It’s very important to always be listening for the feeling behind the words. We do that by listening to the tone, the rhythm of the speech, the hesitations in speech, pauses, slips of the tongue, of course. I’m always interested in any dream material that comes up that will give more access to the unconscious. Then we look for repeating patterns of interaction. We name them and ask the couple to think about why they need this particular pattern. In other words, what defensive function does this pattern serve and what is the anxiety that lies behind it? And there’s always another anxiety that lies behind the most conscious anxiety—fundamentally, the main anxiety is death of the couple. That is the main anxiety.

RM: Death of the couple?

JS: Yes.

RM: Can you say a bit more about that?

JS: Couples are usually not consciously thinking about it, but fundamentally it’s what every couple is worried about. The individual worries that his or her pathology will destroy the couple.

Every couple tries not to remember that one of them will die first.

They consciously worry that they’ll be left, abandoned, rejected, tossed aside, but fundamentally they’re worried that the couple will be destroyed. Every couple tries not to remember that one of them will die first, and no couple knows which one will die first, and no couple knows which one will be left when that happens.

RM: It’s frightening, of course.

JS: It’s very, very frightening when it begins to come to consciousness. As people, maybe in their 40s, they start to maybe lose one friend, or they’ll lose a parent, and they see what happens to the one who is left, then it starts to bear in on them, and they become conscious of that fundamental worry.

RM: How do you work on developing the couple’s state of mind?

JS: The therapist must develop the capacity to be impartial to each individual—or to be equally partial to both of them—but with an overarching commitment to the couple relationship. It’s keeping that in mind that marks the more advanced couple therapist. Someone who isn’t pulled to take sides but who remains neutral, or, if pulled to take a side, latches onto it and can interpret what has just happened. Name it as a skewing of the original intention that reflects a characteristic of the individual who initiated it and the partner who allowed it to happen—since it will likely be a pattern that happens in the relationship. And there you have it, in the laboratory of the couple therapy, where you can see it, examine it in relation to yourself, a couple therapist who doesn’t have all the investment of being a life partner.

RM: Do you have all these concepts in your head when you talk to a couple?

JS: No. I think we do all that theory as background, and if we get stuck in our work with a couple, then we pull out the theory and see if it can help us. But, there’s something very important that you haven’t asked me about, which has to do with sexuality.

RM: By all means….

JS: I’ve found that a lot of couples—or rather couples therapists—don’t actually ask about the couple’s intimate relationship. If a couple presents with a sexual problem they’ll respond to it of course, but they don’t always ask about it as part of the assessment, and I think it’s important to do that, and to not be inhibited about it. It’s just part of the couple’s life and should be considered along with all other aspects. Now, if there is a specific sexual problem, then the object relations approach, which is analytic primarily, has to include a behavioral component.

RM: I know this is hard to quantify, but can you talk about one of your biggest successes and one your biggest failures as a therapist?

JS: That’s really hard to do off the cuff. I mean, there are couples that break up—and in one way, that’s a failure of the couple therapy. In another way, that is a recognition of their differentiation and that the therapy has helped them to reach this very painful decision. Whether you call that a success or a failure is really debatable.

The couple that quits in a rage at you or in disappointment with you—that feels like a failure.

The couple that quits in a rage at you or in disappointment with you—that feels like a failure. It’s also a tremendous loss because you didn't get the opportunity to work with them on these intense feelings which, had they come back to work on them, could have been very useful to their relationship. As it is, they just go off with an idea of putting the bad object into you as if it will stay there, and they’ll be relieved of it. Of course, the bad object always returns, and they won’t have had a chance to really work on it. That feels like a failure to me.

RM: It’s painful, yes.

JS: Success is any couple that goes off, and you never hear from them again because they’re coping. You hope that is a success, but you never really know because part of our policy is not to do follow-up, not to intrude on people’s lives after they have ended their contract with you. That’s one of the sad things about being a couples therapist, is not knowing what happens with them—unless you hear about a couple by chance or unless they return as parents of a child, and they want you then to see their child. They’re doing okay as a couple, but because of the period that they went through when they weren’t doing okay as a couple, their child has built in certain personality characteristics that are hampering that child. So you see the residue of the couple problem in the child.

You can work with the child to get them back on developmental track, but at the same time, you see the couple as parents and how well they are doing both as a couple and as parents, and that’s very gratifying. You could call that a success.

RM: What’s your advice to new therapists?

JS: Get into treatment.

RM: Get into treatment.

JS: And get supervision. And then you can study and take courses. It’s constant work. And if you find a couple daunting, you are not alone. Couple therapy is the hardest work we do because a couple has such a tight bond. They are together because they fit at conscious and unconscious levels.

Success is any couple that goes off, and you never hear from them again because they’re coping.

As the couple therapist, you often feel either you’re breaking a boundary by entering the bedroom, as it were, as if you were a child in an Oedipal situation, or you feel terribly excluded because you can’t get in. You feel guilty about trying to get in. You feel confused, puzzled, rejected. It can be very uncomfortable working with a couple, and this is the reason many people don’t do it, I think. That’s why I say get into therapy and supervision. It takes a lot of personal therapy on the part of the therapist to understand how their own personality is constructed and how they tend to express themselves not only in their personal relationships, but in relation to the couples and families they work with.

Jill Savege Scharff, MD is Co-director of the International Psychotherapy Institute and Chair of the International Institute for Psychoanalytic Training. She is Clinical Professor of Psychiatry at Georgetown University Medical School and Teaching Analyst at the Washington Psychoanalytic Institute. Her private practice in Chevy Chase, Maryland is concentrated on psychoanalysis with children and adults, and on couple and family therapy.

Dr. Scharff edited Foundations of Object Relations Family Therapy, (1989) and The Autonomous Self: The Work of John D. Sutherland (1994). She wrote Projective and Introjective Identification: The Therapists Use of Self (1992). With David E. Scharff, M.D. she co-authored Object Relations Family Therapy (1987), Object Relations Couple Therapy (1991), Scharff Notes: A Primer of Object Relations Therapy (1992 and 2nd edition 2005), Object Relations Therapy of Physical and Sexual Trauma (1994), Object Relations Individual Therapy (1998), Tuning the Therapeutic Instrument: The Affective Learning of Psychotherapy (2000), and co-editor of Self Hatred in Psychoanalysis: Detoxifying the Persecutory Object (2003) and The Legacy of Fairbairn and Sutherland (2005). She is series co-editor of the Library of Object Relations at Jason Aronson, Inc.

Dr. Scharff has been the invited guest speaker at scientific meetings, symposia and workshops on psychoanalysis, marital and family therapy throughout the United States and Europe. She is also interested in social dance and theatre. She founded the Cosmos Club Theatre in Washington D.C. where members' plays are performed in readers theatre and put into workshop.

Rafal Mietkiewicz is a clinical psychologist working in private practice in Gdańsk, Poland. He is trained as a Gestalt psychotherapist, and includes an existential approach in his work. Apart from classical psychological knowledge, he takes a lot of inspiration from literature, art and philosophy. He is a dedicated vegan, runner and triathlete.